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Shi L, Li T, Luck J, Ghanem B. The Association of Medicaid expansion with prescription drug utilization and expenditure among low-income participants with asthma. J Asthma 2023; 60:2030-2039. [PMID: 37171903 DOI: 10.1080/02770903.2023.2213331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/10/2023] [Accepted: 05/08/2023] [Indexed: 05/14/2023]
Abstract
OBJECTIVE This study estimated the association between the 2014 Medicaid expansion and asthma-related prescription drug utilization and expenditures among low-income adult participants with asthma, including those with uncontrolled asthma, in the United States. METHODS In this national analysis, using a pooled dataset from 2007-2018 Medical Expenditure Panel Surveys (MEPS), regression discontinuity (D-RD) analyses estimated the association between Medicaid expansion and utilization of and expenditures for asthma-related prescription drugs among participants with asthma aged 26-64 with incomes below vs. at/above 138% of the federal poverty level (FPL). A sub-sample analysis was also conducted among participants with uncontrolled asthma. Utilization and expenditure outcomes were estimated using two-part models with logit as the first part and generalized linear models as the second part. RESULTS Utilization of and total cost for asthma-related prescription drugs increased by 1.89 fills (p < 0.001) and $306.59 (p < 0.001) among participants with asthma with income below 138% FPL after Medicaid expansion. The utilization and total cost of both short-acting bronchodilators and inhaled corticosteroids (ICSs) increased after Medicaid expansion among participants with asthma with incomes below 138% FPL. Among participants with uncontrolled asthma with incomes below 138% FPL, utilization and expenditures increased after Medicaid expansion for all asthma-related prescription drugs and short-acting bronchodilators. CONCLUSION Medicaid expansion was associated with increased utilization of and total expenditures for both quick-relief and preventive asthma medications among all low-income participants with asthma, but not with utilization of preventive medications among those with uncontrolled asthma.
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Affiliation(s)
- Lu Shi
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Tao Li
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jeff Luck
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Buthainah Ghanem
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, Chapman University, Irvine, CA, USA
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Shi L, Yoon J, Li T, Jeff L. The impact of Medicaid expansion on asthma-related health care services utilization and expenditure. J Asthma 2023; 60:43-56. [PMID: 34978935 DOI: 10.1080/02770903.2021.2025389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of Medicaid expansion on asthma-related health care services utilization and expenditures among low-income adult patients with asthma aged 26-64. METHODS Using a pooled dataset from 2007 to 2018 Medical Expenditures Panel Surveys (MEPS), we implemented a multivariate difference-in-differences analysis, which compared changes in utilization and expenditures for asthma-related health care services among adult patients with asthma with income below 133% Federal Poverty Level (FPL) vs. above 133%-400% FPL, before and after Medicaid expansion in 2014. We used negative binomial models to analyze utilization outcomes. Expenditures were estimated using two-part models with logit as the first part and generalized linear models as the second part. Estimates were weighted for the complex multi-stage sampling design of MEPS. RESULTS Medicaid expansion was associated with increases in both utilization and expenditures for asthma-related prescription drugs among low-income patients with asthma, by 1.8 prescription fills (p < 0.05) and $233 (p < 0.05) per year, respectively. No statistically significant association was detected for other asthma-related health care services. CONCLUSION Medicaid expansion led to an increase in accessibility of prescription drugs among low-income asthma patients, but had no effect on other asthma-related health care services.
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Affiliation(s)
- Lu Shi
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jangho Yoon
- Department of Preventive Medicine and Biostatistics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tao Li
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Luck Jeff
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Liu J, Zhang X, Wang B, Dai H, Dou D, Fang W. Trends in anti-HER2 drugs consumption and influencing factors. Front Public Health 2022; 10:944071. [PMID: 36159303 PMCID: PMC9493110 DOI: 10.3389/fpubh.2022.944071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023] Open
Abstract
Background Human epidermal growth factor receptor 2 (HER2) inhibitors have been approved to treat various cancers with HER2 amplification. The Chinese government has made great efforts to improve the availability and affordability of these drugs. This study aimed to analyze the trends in anti-HER2 drug consumptions in Nanjing from 2012 to 2021, and explore influencing factors. Methods Data about use of anti-HER2 drugs in 2012-2021 were extracted from Jiangsu Medicine Information Institute. Six types of anti-HER2 drugs were included. Drug consumption was expressed as defined daily doses (DDDs) and expenditure. Time series analysis was adopted to find trends in consumption, while interrupted time series was used in analyzing the impact of policy on consumption. The correlation between DDDs and defined daily cost (DDC) was analyzed by Pearson's correlation test. Results The DDC, DDDs, and expenditure of anti-HER2 drugs changed little from 2012 to 2016. The DDC decreased intermittently, while the DDDs and expenditure of these drugs grew continuously from 2017 to 2021. The anti-HER2 monoclonal antibodies contributed to the majority of total consumption in 2012-2019. The DDDs of anti-HER2 tyrosine kinase inhibitors surpassed the DDDs of monoclonal antibodies in 2020-2021. Trastuzumab was the predominantly prescribed drug in 2012-2019, but the DDDs of pyrotinib surpassed the DDDs of trastuzumab in 2020-2021. The ln value of DDC or self-paid DDC of trastuzumab was negatively correlated with the ln value of its DDDs. The national health insurance coverage (NHIC) and national drug price negotiation policy about anti-HER2 drugs were initiated in 2017. Low-price generics and biosimilar of trastuzumab came into the market in 2020 and 2021, separately. Interrupted time series analysis showed that the DDDs increased significantly after the implementation of NHIC, price negotiation or generic drug replacement. Conclusion The consumption of anti-HER2 drugs has significantly increased and their DDC has decreased after the implementation of NHIC, price negotiation, or low-price generic drug replacement since 2017. Further efforts are needed to translate the high consumption into clinical benefits.
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Affiliation(s)
- Jie Liu
- Department of Pharmacy, Nanjing Pukou Central Hospital, Pukou Branch of Jiangsu Province Hospital, Nanjing, China
| | - Xiaolei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Biao Wang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huizhen Dai
- Department of Pharmacy, Jiangsu Medicine Information Institute, Nanjing, China
| | - Dahai Dou
- Department of Pharmacy, Nanjing Pukou Central Hospital, Pukou Branch of Jiangsu Province Hospital, Nanjing, China,Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wentong Fang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Wentong Fang
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Wu D, Xie J, Dai H, Fang W. Consumption and cost trends of EGFR TKIs: influences of reimbursement and national price negotiation. BMC Health Serv Res 2022; 22:431. [PMID: 35365136 PMCID: PMC8973903 DOI: 10.1186/s12913-022-07868-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been widely used in the treatment of EGFR mutation non-small-cell lung cancer. The Chinese government has made great efforts to improve the availability and affordability of these drugs. The aim of this study was to investigate the trends in the consumption and cost of EGFR TKIs in Nanjing, a developed city in China, and evaluate the influence of health insurance coverage and national price negotiation on drug consumption. Methods Data about EGFR TKIs applications in 2010–2019 were extracted from Jiangsu Medicine Information Institute. Five types of EGFR TKIs were included. Consumption was expressed in defined daily doses (DDDs) and expenditure. The correlation between defined daily cost (DDC) and DDDs was analyzed by Pearson's correlation test. Results The DDC, number of DDDs and expenditure of EGFR TKIs changed little from 2010 to 2015. National price negotiation was initiated as a policy and low-price generic gefitinib came into the market in 2016. Three types of EGFR TKIs moved into the coverage of the national health insurance since 2017. Hence, the DDC decreased, and the number of DDDs increased significantly year by year since 2016. The first generation TKIs always made up of comprised the majority of the total consumption. The predominantly prescribed TKIs were gefitinib and icotinib. DDC was negatively correlated with the number of DDDs. The number of DDDs increased significantly after health insurance enrollment, price negotiation and generic drug replacement. Conclusion The consumption of EGFT TKIs has increased and the DDC of EGFR TKIs has decreased since 2016. These trends may be attributed to drug reimbursement, price negotiation and generic drug replacement. Further efforts are needed to translate the high consumption of EGFR TKIs into clinical benefits. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07868-9.
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Affiliation(s)
- Di Wu
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China
| | - Jianxiang Xie
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China
| | - Huizhen Dai
- Department of Pharmacy, Jiangsu Medicine Information Institute, Nanjing, 210029, China
| | - Wentong Fang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China.
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Ayubcha C, Pouladvand P, Ayubcha S. A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast. Front Public Health 2021; 9:707907. [PMID: 34869142 PMCID: PMC8637894 DOI: 10.3389/fpubh.2021.707907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings. Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urban mortality rates [1999–2018]. Counties encompassing the largest cities in the Northeastern Megalopolis (Washington D.C., Baltimore, Philadelphia, New York City, and Boston) were selected as treatment units (n = 5 cities, 3,543,302 individuals in 2018). Cities in states without Medicaid expansion were utilized as control units (n = 17 cities, 12,713,768 individuals in 2018). Results: Across all cities, there was a significant reduction in the neoplasm (Population-Adjusted Average Treatment Effect = −1.37 [95% CI −2.73, −0.42]) and all-cause (Population-Adjusted Average Treatment Effect = −2.57 [95%CI −8.46, −0.58]) mortality rate. Washington D.C. encountered the largest reductions in mortality (Average Treatment Effect on All-Cause Medical Mortality = −5.40 monthly deaths per 100,000 individuals [95% CI −12.50, −3.34], −18.84% [95% CI −43.64%, −11.67%] reduction, p = < 0.001; Average Treatment Effect on Neoplasm Mortality = −1.95 monthly deaths per 100,000 individuals [95% CI −3.04, −0.98], −21.88% [95% CI −34.10%, −10.99%] reduction, p = 0.002). Reductions in all-cause medical mortality and neoplasm mortality rates were similarly observed in other cities. Conclusion: Significant reductions in urban mortality rates were associated with Medicaid expansion. Our study suggests that Medicaid expansion saved lives in the observed urban settings.
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Affiliation(s)
| | - Pedram Pouladvand
- Alfred I. DuPont Hospital for Children, Wilmington, NC, United States
| | - Soussan Ayubcha
- Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
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Lindner S, Levy A, Horner-Johnson W. The Medicaid expansion did not crowd out access for medicaid recipients with disabilities in Oregon. Disabil Health J 2020; 14:101010. [PMID: 33419718 DOI: 10.1016/j.dhjo.2020.101010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/02/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) substantially increased the number of Medicaid enrollees, which could have reduced access to health care services for those already on Medicaid before the expansion. OBJECTIVE To examine the association of the ACA expansion on health care access and utilization for adults ages 18-64 years who have qualified for Supplemental Security Income (SSI) in Oregon. METHODS We used Oregon Medicaid claims and enrollment data from 2012 to 2015 and information from the American Community Survey and the Local Area Unemployment Statistics. Multivariate regressions compared changes in health care access and utilization before and after the expansion among Medicaid recipients who qualified for SSI across counties in Oregon with higher and lower Medicaid enrollment increases due to the expansion. Health care access and utilization outcome measures included: primary care visits, non-behavioral health outpatient visits, behavioral health outpatient visits, emergency department (ED) visits and potentially avoidable ED visits. RESULTS The Medicaid expansion led to an uneven increase in Medicaid enrollment across Oregon's counties (mean increase from the first quarter of 2012 to the third quarter of 2015: 12.4% points; range: 7.3 to 18.6% points). Access and utilization outcomes for SSI Medicaid recipients were mostly unaffected by differential enrollment increases. ED visits increased more in counties with a larger Medicaid enrollment increase (estimate: 1.8, p < 0.05), but adjusting for pre-expansion trends eliminated this association. CONCLUSIONS We did not find evidence that an increase in Medicaid enrollment due to the ACA negatively impacted access and utilization for adult Medicaid recipients on SSI, who were eligible for Medicaid prior to expansion.
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Affiliation(s)
- Stephan Lindner
- OHSU Center for Health System Effectiveness (CHSE), Department of Emergency Medicine, School of Medicine, 3030 SW Moody Ave, Portland, 97201, OR, USA; OHSU-PSU School of Public Health, Portland 97239, OR, USA.
| | - Anna Levy
- OHSU Center for Health System Effectiveness (CHSE), Department of Emergency Medicine, School of Medicine, 3030 SW Moody Ave, Portland, 97201, OR, USA
| | - Willi Horner-Johnson
- OHSU-PSU School of Public Health, Portland 97239, OR, USA; OHSU Institute on Development and Disability, Department of Pediatrics, School of Medicine, Portland, 97239, OR, USA
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Cai C, Runte J, Ostrer I, Berry K, Ponce N, Rodriguez M, Bertozzi S, White JS, Kahn JG. Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLoS Med 2020; 17:e1003013. [PMID: 31940342 PMCID: PMC6961869 DOI: 10.1371/journal.pmed.1003013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach. METHODS AND FINDINGS We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis. CONCLUSIONS In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available.
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Affiliation(s)
- Christopher Cai
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Jackson Runte
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Isabel Ostrer
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kacey Berry
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Ninez Ponce
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Michael Rodriguez
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Stefano Bertozzi
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Justin S. White
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Rai P, Zhao X, Sambamoorthi U. The Association of Joint Pain and Dipeptidyl Peptidase-4 Inhibitor Use Among U.S. Adults With Type-2 Diabetes Mellitus. J Pain Palliat Care Pharmacother 2019; 32:90-97. [PMID: 30676844 DOI: 10.1080/15360288.2018.1546789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to examine the association of dipeptidyl peptidase-4 inhibitors (DPP4Is) with joint pain in adults with type 2 diabetes mellitus (T2DM). This was a retrospective cross-sectional study design, pooling data from the 2012 and 2014 Medical Expenditure Panel Survey. The sample consisted of 4,559 T2DM patients older than 40 years with (n = 3,224) or without joint pain (n = 1,335). Chi-square test and logistic regression were used to describe association of DPP4I use with joint pain. Among adults with T2DM, 70.7% reported physician-diagnosed joint pain. There were no significant differences in DPP4I use among those with and without joint pain (7.8% vs 6.3%). Even after adjusting for other factors that may affect DPP4I use, there was not a statistically significant difference in DPP4I use among adults with T2DM with and without joint pain (AOR = 1.04; 95% CI, 0.74-1.48). Adults with public health insurance (AOR = 1.76; 95% CI, 1.01-3.04), with prescription insurance (AOR = 1.76; 95% CI, 1.02-3.03), and with a heart disease (AOR = 1.59; 95% CI, 1.18-2.15). DPP4I use was not affected by the presence of joint pain.
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